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ABO blood type incompatibility does not increase risk of corneal transplant failure

Am J Ophthalmol. 2009;147(3): 432-438.

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ABO blood type compatibility did not play a role in corneal transplant failure stemming from graft rejection in low-risk cases.

Investigators aimed to determine whether ABO compatibility affected 5-year corneal graft survival in patients undergoing corneal transplantation for Fuchs' dystrophy or pseudophakic corneal edema.

The prospective, multicenter, double-masked clinical trial included 1,002 corneal donors and recipients participating in the Cornea Donor Study. Investigators determined ABO compatibility, documented graft failures during a 5-year follow-up period and classified graft failures based on attributability to immunologic rejection.

The primary outcome was graft failure attributed to rejection. The secondary outcomes included the incidence of rejection, with or without ensuing graft failure, and graft failure attributed to any cause.

Sixty-four percent of the recipients were ABO compatible with their donors, 86% were Rh compatible and 54% were ABO and Rh compatible, the authors reported.

Results showed a 5-year cumulative incidence of graft failure attributable to rejection of 6% among ABO compatible recipients and 4% among ABO incompatible recipients. The 5-year incidence of rejection, regardless of whether a graft failure occurred, was 12% among ABO compatible patients and 8% among ABO incompatible cases (P = .09). Endothelial cell loss was similar in ABO compatible and incompatible clear grafts at 5 years.